Outcome of Composite Graft Uptake in Fingertip Amputation in All Age Groups

Khurshid  Alam; Shahid  Hameed; Muhammad Ali  Nasir; Farman  Mehmood; Khawja Umer  Majeed; Abdul  Qadeer

doi:10.51253/pafmj.v75iSUPPL-6.9490

Authors

Khurshid Alam Department of Plastic Surgery, Combined Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Shahid Hameed Department of Plastic Surgery, Combined Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Muhammad Ali Nasir Department of Plastic Surgery, Combined Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Farman Mehmood Department of Plastic Surgery, Combined Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Khawja Umer Majeed Department of Plastic Surgery, Combined Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Abdul Qadeer Department of Plastic Surgery, Combined Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v75iSUPPL-6.9490

Keywords:

Composite Grafting, Digital Amputation, Graft Survival

Abstract

Objective: To determine the outcome of composite grafting for fingertip amputation in terms of graft survival.

Study Design: Prospective longitudinal study

Place and Duration of Study: Department of Plastic Surgery, Combined Military Hospital, Rawalpindi Pakistan from, Jan 2020 to Sep 2022.

Methodology: We conducted this study on 174 adults with distal upper limb digital amputations. Patients of both genders between the age of 5 and 80 years were included. Patients with previous surgery for same injury, multiple amputations or complex injuries or compartment syndrome were excluded. All patients received repair with a composite graft and were followed-up for one-year post-procedure to assess outcomes and monitor for complications. Data was analyzed using SPSS 26.0.

Results: The study sample had a median age of 32.00 (IQR: 22.00) years, with males accounting for a majority of the cases i.e., 136(78.2%). Graft failure was seen in 27(15.5%) patients. A total of 12(6.9%) patients required revision surgery. Neuromas and surgical site infections were seen in 9(5.2%) and 7(4.0%) patients, respectively, while 13(7.5%) patients complained of significant pain in the re-implanted digit at one-year, post-surgery. Advancing patient age (p=0.010), a longer time elapsed from trauma to surgery (p<0.001) and development of surgical site infections (p<0.001) were all associated with graft failure.

Conclusion: Composite grafting is associated with good outcomes in patients with digital amputations in-terms of graft survival.

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References

1 Pencle FJ, Doehrmann R, Waseem M. Fingertip Injuries. In: StatPearls [Internet]. Treasure Island (FL): Stat Pearls Publishing; 2022 Jan-. Available from:

https://www.ncbi.nlm.nih.gov/books/NBK436006/

2 Schultz J, Wruck JE, Trips E, Pfeiffer R, Grählert X, Münchow S, et al. Semi-occlusive management of fingertip injuries with finger caps: A randomized controlled trial in children and adults. Medicine (Baltimore) 2022; 101(27): e29324.

https://doi.org/10.1097/MD.0000000000029324

3 Kawaiah A, Thakur M, Garg S, Kawasmi SH, Hassan A. Fingertip Injuries and Amputations: A Review of the Literature. Cureus. 2020 May 26; 12(5): e8291.

https://doi.org/10.7759/cureus.8291

4 Aslam A, Aman S, Saleem N, Ali A, Rizwan S, Ikram A. Functional Compatibility of Local Flaps for Coverage of Digital Skin Defects. J Coll Physicians Surg Pak 2022; 32(1): 92-95.

https://doi.org/10.29271/jcpsp.2022.01.92

5 Kwon SH, Lao WW, Hsu AT, Lee CH, Hsu CC, Huang JJ, et al. The Preferred Management of a Single-Digit Distal Phalanx Amputation. J Reconstr Microsurg 2020; 36(4): 301-310.

https://doi.org/10.1055/s-0039-1701013

6 Al-Ali MA, Abu-Zidan FM. Auricular avulsion injuries: Literature review and management algorithm. Turk J Emerg Med 2022; 22(2): 59-66.

https://doi.org/10.4103/2452-2473.342811

7 Lee Y, Heo JW, Moon JS, Kim SW, Kim J. Effects of hyperbaric oxygen on graft survival outcomes in composite grafting for amputated fingertip injury. Arch Plast Surg 2020; 47(5): 444-450. https://doi.org/10.5999/aps.2020.00381

8 Borrelli MR, Landin ML, Agha R, Greig A. Composite grafts for fingertip amputations: A systematic review protocol. Int J Surg Protoc. 2019; 16(1): 1-4.

https://doi.org/10.1016/j.isjp.2019.05.001

9 Hirasé Y. Postoperative cooling enhances composite graft survival in nasal-alar and fingertip reconstruction. Br J Plast Surg 1993; 46(8): 707-711.

https://doi.org/10.1016/0007-1226(93)90204-o

10 Koh SH, Park I, Kim JS, Lee DC, Roh SY, Lee KJ, et al. Fingertip reconstruction with a subcutaneous flap and composite graft composed of nail bed and volar pulp skin. Arch Plast Surg 2022; 49(1): 70-75.

https://doi.org/10.5999/aps.2021.01200

11 Borrelli MR, Dupré S, Mediratta S, Bisquera A, Greig A. Composite Grafts for Pediatric Fingertip Amputations: A Retrospective Case Series of 100 Patients. Plast Reconstr Surg Glob Open 2018 Jun 19; 6(6): e1843.

https://doi.org/10.1097/GOX.0000000000001843

12 Kawaiah A, Thakur M, Garg S, Kawasmi SH, Hassan A. Fingertip Injuries and Amputations: A Review of the Literature. Cureus 2020; 12(5): e8291.

https://doi.org/10.7759/cureus.8291

13 Bielewicz J, Daniluk B, Kamieniak P. VAS and NRS, Same or Different? Are Visual Analog Scale Values and Numerical Rating Scale Equally Viable Tools for Assessing Patients after Microdiscectomy? Pain Res Manag 2022; 2022(1): 5337483.

https://doi.org/10.1155/2022/5337483

14 Dębski T, Noszczyk BH. Epidemiology of complex hand injuries treated in the Plastic Surgery Department of a tertiary referral hospital in Warsaw. Eur J Trauma Emerg Surg 2021; 47(5): 1607-1612. https://doi.org/10.1007/s00068-020-01312-5

15 Elzinga K, Chung KC. Non-microsurgical Composite Grafting for Acute Management of Fingertip Amputation. Hand Clin 2021; 37(1): 43-51.

https://doi.org/10.1016/j.hcl.2020.09.007

16 Borrelli MR, Dupré S, Mediratta S, Bisquera A, Greig A. Composite Grafts for Pediatric Fingertip Amputations: A Retrospective Case Series of 100 Patients. Plast Reconstr Surg Glob Open 2018; 6(6): e1843.

https://doi.org/10.1097/GOX.0000000000001843

17 Alper N, Sood A, Granick MS. Composite graft repair for distal fingertip amputation. Eplasty 2013; 13(1): IC32.

18 Larsen MT, Eldridge-Allegra I, Wu J, Jain SA. Patients admitted for treatment of traumatic finger amputations: Characteristics, causes, and prevention. J Clin Orthop Trauma 2019 10(5): 949-953. https://doi.org/10.1016/j.jcot.2019.01.024

19 Long C, Suarez PA, Hernandez-Boussard T, Curtin C. Disparities in Access to Care Following Traumatic Digit Amputation. Hand (N Y) 2020; 15(4): 480-487.

https://doi.org/10.1177/1558944718824700

20 Landin ML, Borrelli MR, Sinha V, Agha R, Greig AV. Composite grafts for fingertip amputations: a systematic review. Int J Surg Short Rep 2021: 6(1): e17.

https://doi.org/10.1097/SR9.0000000000000017

21 Ono S, Chung KC. Efficiency in Digital and Hand Replantation. Clin Plast Surg 2019; 46(3): 359-370.

https://doi.org/10.1016/j.cps.2019.03.002

22 Harbour PW, Malphrus E, Zimmerman RM, Giladi AM. Delayed Digit Replantation: What is the Evidence? J Hand Surg Am 2021; 46(10): 908-916.

https://doi.org/10.1016/j.jhsa.2021.07.007.

23 Gangadharan R, Roslee C, Kelsall N, Taylor H. Retrospective review of complications following long tourniquet time in foot and ankle surgery. J Clin Orthop Trauma 2020; 16(1):189-194.

https://doi.org/10.1016/j.jcot.2020.12.023

24 Greenblatt DY, Rajamanickam V, Mell MW. Predictors of surgical site infection after open lower extremity revascularization. J Vasc Surg 2011; 54(2):433-439.

https://doi.org/10.1016/j.jvs.2011.01.034